Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after January 1, 2023, the following Clinical Criteria were developed and might result in services that were previously covered but may now be found to be not medically necessary.

 

ING-CC-0219

Korsuva (difelikefalin acetate)

 

Access the Clinical Criteria document information.

 

Anthem Blue Cross and Blue Shield’s medical specialty drug review team will manage prior authorization clinical review of non-oncology specialty pharmacy drugs. Drugs used for the treatment of Oncology will be managed by AIM Specialty Health_® (AIM).*

  

* AIM Specialty Health is an independent company providing administrative services on behalf of Anthem Blue Cross and Blue Shield.
GABCBS-CM-006570-22